Mahi Gagandeep, Ansong Eric, Gan Eugene, Dehbozorgi Sasan, Chong Han Hong
Kettering General Hospital NHS Foundation Trust, Kettering, UK.
Brighton and Sussex NHS Foundation Trust, Brighton, UK.
Hand (N Y). 2024 Oct 18:15589447241284670. doi: 10.1177/15589447241284670.
The 2 primary surgical approaches for proximal interphalangeal joint (PIPJ) arthroplasty, dorsal or volar, have been extensively described in the literature. However, the ongoing debate regarding which approach offers superior results or is associated with fewer complications persists. This systematic review aims to compare the outcomes of PIPJ arthroplasty between the dorsal and volar approaches.
A comprehensive search of multiple databases was conducted, and studies meeting predetermined criteria were included. Data extraction, assessment of bias risk, and statistical analysis were performed to compare treatment modalities. Outcome measures included range of motion (ROM), patient-reported outcome measures (PROMs), revisions, and reported complications.
Among 368 screened articles, 5 studies involving 302 patients (310 implants) were eligible for final review. No significant differences were observed between the 2 approaches regarding postoperative ROM (mean difference [MD] 2.24; 95% confidence interval [CI] -3.83, 8.32; = .47) and PROMs (standardized mean difference [SMD] 0.18; 95% CI -0.12, 0.48; = .25). Complication rates, including revision/fusion, persistent pain, stiffness, infection, and dislocation, did not significantly differ between the approaches. Notably, dorsal approach was associated with higher risk of swan-neck deformity (9 out of 82 implants), while no such cases were reported in the volar approach (0 out of 101 implants).
Despite limitations and heterogeneity in the literature, both dorsal and volar approaches for PIPJ arthroplasty appear to yield equivalent outcomes for patients.
II, therapeutic.
近端指间关节（PIPJ）置换术的两种主要手术入路，即背侧入路和掌侧入路，在文献中已有广泛描述。然而，关于哪种入路能带来更好的效果或并发症更少的争论仍在继续。本系统评价旨在比较背侧入路和掌侧入路的PIPJ置换术的结果。
对多个数据库进行全面检索，纳入符合预定标准的研究。进行数据提取、偏倚风险评估和统计分析以比较治疗方式。结局指标包括活动范围（ROM）、患者报告的结局指标（PROMs）、翻修情况和报告的并发症。
在368篇筛选的文章中，5项研究涉及302例患者（310枚植入物）符合最终评价标准。两种入路在术后ROM（平均差[MD]2.24；95%置信区间[CI] -3.83，8.32；P = 0.47）和PROMs（标准化平均差[SMD]0.18；95%CI -0.12，0.48；P = 0.25）方面未观察到显著差异。包括翻修/融合、持续疼痛、僵硬、感染和脱位在内的并发症发生率在两种入路之间没有显著差异。值得注意的是，背侧入路与鹅颈畸形的风险较高相关（82枚植入物中有9例），而掌侧入路未报告此类病例（101枚植入物中有0例）。
尽管文献存在局限性和异质性，但PIPJ置换术的背侧和掌侧入路对患者似乎都能产生等效的结果。
II级，治疗性。
